Does Walking Help to Generate a Differential Diagnosis?

Abstract

TheoryIn Medicine, arriving at the correct diagnosis is of paramount importance for patient health and safety, yet is a difficult task especially when a patient presents with symptoms that do not fit typical patterns of disease. This task can be further complicated by errors of judgment, with the failure to consider all possible diagnoses being the most common of such errors. In this study, we investigated the process of differential diagnosis generation within the growing evidence that diagnostic performance can be increased by activities such as walking as was previously shown in Oppezzo and Schwartz’s 2014 study. Hypotheses: It was hypothesized that an increase in performance, as expressed by a greater number of plausible differential diagnoses, would be seen in the walking group. Method: Eighteen medical students in their last two months of pre-clerkship training and eighteen second year family medicine residents were shown four different lists of a constellation of signs and symptoms. Participants were asked to generate differential diagnoses over five minutes per each list. All participants sat when completing the first two lists (pretest phase), and then were equally and randomly assigned to sitting versus walking on a treadmill when completing the last two lists (post-test phase). The number of total and unique differential diagnoses generated was determined, before being submitted to a three-member expert panel who identified appropriate unique differential diagnoses. Results: Two-way mixed ANOVAs were conducted to investigate the impact of exercise on the number of total, unique, and appropriate unique ideas generated and compared between pretest and post-test phases. Conclusions: We conclude that there is neither an increase nor a decrease in the number or quality of differential diagnoses generated by the sitting and walking groups within a population that has acquired some level of expertise.

Keywords:

• differential diagnosis
• exercise
• medical education
• clinical reasoning

Acknowledgements

The authors would like to thank Drs. Rob Billington, Jill Farrukh, and Jason Hosain from the University of Saskatchewan Department of Academic Family Medicine for generously agreeing to be part of our 3-member panel of experts. A thank you also goes out to Mr. Richard Franke, research assistant, for his help with data collection, often at distributed educational sites across Saskatchewan.

Disclosure statement

No potential competing interest was reported by the authors.

Data availability

The data that support the findings of this study are available from the corresponding author, MEK, upon reasonable request.